For many women, breast cancer screening does not become part of the healthcare conversation until age 40. However, one of the most important conversations a physician can have with women about breast health should come much earlier.
With more women being diagnosed with breast cancer at an earlier age, ACR® recommends that women talk to their doctor about their breast cancer risk by age 25. While annual mammography beginning at age 40 remains the recommendation for women at average risk, the purpose of early risk assessment is to identify those who may benefit from a more personalized screening strategy long before routine screening begins.
So why age 25?
The recommendation reflects an important reality: breast cancer risk is not the same for everyone. While age is a significant risk factor, family history, inherited genetic mutations, prior chest radiation, breast density and other factors can all influence a person's likelihood of developing breast cancer. Understanding those risks earlier provides an opportunity to tailor care based on individual circumstances rather than relying solely on age-based recommendations.
For some women, that information may not change anything immediately. For others, it could have a substantial impact on future screening decisions.
Individuals identified as high risk may benefit from earlier screening or supplemental imaging such as breast MRI. The earlier those risk factors are recognized, the more time patients and their healthcare teams have to develop an appropriate screening plan.
The recommendation is particularly important because some populations face higher risks or poorer outcomes. Black women are more likely to be diagnosed with aggressive breast cancers and experience higher breast cancer mortality rates. Identifying elevated risk earlier can help ensure that these patients receive screening recommendations tailored to their specific needs.
Risk assessment also supports radiology's broader movement toward more personalized care. Rather than treating breast cancer screening as a one-size-fits-all process, risk-based approaches recognize that effective screening strategies should account for each patient's unique health history.
That principle extends to transgender individuals as well. Factors such as anatomy, hormone therapy, family history and genetics can all influence breast cancer risk. Comprehensive risk assessment allows healthcare providers to develop screening recommendations based on individual circumstances rather than assumptions.
Importantly, risk assessment is not designed to replace screening recommendations. Instead, it serves as the foundation for determining whether standard screening guidelines are appropriate or whether additional considerations may be warranted.
For radiologists, encouraging awareness of risk assessment may be one of the most effective ways to support earlier identification of high-risk patients and advance more personalized breast cancer care. The goal is not simply to screen more patients, but to ensure that every patient receives the screening strategy that best matches their risk.
As we observe Breast Cancer Awareness Month, conversations about mammography and early detection remain as important as ever. At the same time, we have an opportunity to broaden the discussion.
Awareness should include understanding risk.
ACR has resources available through Mammography Saves Lives to help guide the necessary conversations about breast cancer risk.
When it comes to breast cancer prevention and early detection, one of the most important questions may not be when screening starts, but whether risk was understood early enough to inform that decision.
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